Provider Demographics
NPI:1518651256
Name:FALEIRO, CHRISLEIGH ANN OLGA
Entity Type:Individual
Prefix:
First Name:CHRISLEIGH
Middle Name:ANN OLGA
Last Name:FALEIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5076 COLLEGE GARDENS CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1102
Mailing Address - Country:US
Mailing Address - Phone:415-819-2941
Mailing Address - Fax:
Practice Address - Street 1:4602 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3236
Practice Address - Country:US
Practice Address - Phone:608-616-5897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI6001271-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program